Paton Blough thought a Mississippi police officer was going to kill him, so he hopped in his car and sped out of the state.
He debated whether to go his home in Greenville, South Carolina, or to Washington, D.C. Instead, he ended up in Alabama, armed himself with a shotgun and led police on a high-speed chase along Interstate 20.
He was 29 then and this was his first of six arrests – all during manic bipolar episodes.
“I’ve had nights where I’ve even had officers say if there would’ve been a hospital bed available, they would’ve taken me there. But instead I ended up in a jail cell,” said Blough, now 40 years old and an advocate for people with mental illness.
That all changed for people like Blough under the protections provided by the Affordable Care Act, which required mental health services to be covered by insurers.
Roughly 1.8 million people who live with mental illness received care in medical facilities or mental health services, rather than being tossed in jail, because of the ACA, according to Richard Frank, a health economics professor at Harvard, and Sherry Glied, dean of New York University’s Wagner Graduate School of Public Service, who wrote an opinion piece for The Hill.
Now that coverage could disappear. If the Senate passes the Republican bill to replace Obamacare that advanced through the House of Representatives, states will have the option of waiving the ACA’s requirement that all individual insurance companies cover 10 “essential health benefits,” including mental health and substance abuse services.
“And that’s just scary, because if you put a waiver on things like mental health . . . that would be a concern, I think, to the citizens of South Carolina,” said Bill Lindsey, executive director for National Alliance on Mental Illness in the state. “This one doesn’t help us.”
Patient advocates from South Carolina identified two other potentially troublesome provisions of the legislation.
One would allow states to opt out of the ACA’s “community rating” rule, which prevents individual insurers from charging sick people more for coverage. The other would slash nearly $900 billion in funding for the Medicaid program.
For a state like South Carolina, whose Medicaid-enrolled population as of February accounted for 20 percent of the population, these provisions create a dangerous situation for people with mental illness.
“When you’re talking about mental health spending or the availability of care, the crux of the matter is that when that’s not available, the jails become de facto mental health facilities for people in severe crisis,” said Blough, a board member of National Alliance on Mental Illness in South Carolina.
Blough, frustrated with D.C. politicians, is trying to gather enough signatures to challenge South Carolina Republican Rep. Trey Gowdy for his seat in 2018. Blough is running as an independent on a platform that includes support for improved access to mental health services.
“People don’t always correlate Medicaid to mental health when that’s where people with mental health disorders, by and large because of the income disparity, those are the types of services they need to stay healthy,” Blough said.
With the GOP health care plan, Republicans are trying to keep some of the popular aspects of the ACA, such as making sure people are not denied coverage of pre-existing conditions, while trying to cut taxes, reduce federal mandates, lower insurance premiums and create more competition in state health insurance marketplaces.
Republican lawmakers who support the plan are trying to ease concerns about the potential effect of the legislation on South Carolinians with mental illness.
Sen. Tim Scott told McClatchy that many senators, including those in his party, strongly supported funding for mental health and substance abuse treatment.
“You’ll see a renewed emphasis and focus on making sure that the resources are available,” Scott said. “And, frankly, I think that the spending in the current health care law, as well as in other programs, the mental health component is a very important part. I think you can count on it being preserved in like fashion.”
Gowdy, who supports the GOP health care bill and could be challenged in his re-election bid by Blough, declined to comment.
Twila Brase, president and co-founder of the conservative Citizens’ Council for Health Freedom, argued that the ACA mandates, including the essential benefits requirement, could already be hurting the mentally ill who depend on coverage, by reducing the number of charity programs that could provide alternative care for them.
“There’s other angles to look at, rather than just that there’s the opportunity for states to say: ‘No, we’re not going to mandate these,’ ” Brase said. “That doesn’t mean that health care won’t be offered to them, doesn’t mean they won’t be available in other ways. In fact, they might be more inexpensive as a result of not being mandated any longer.”
Ashley Landess, president of the South Carolina Policy Council, a conservative think tank, said she was fed up with government interference in health care.
“We should not be letting politicians dictate what can be covered,” Landess said. “This is the whole problem. And what starts out as a well-intentioned plan to aid lower-income citizens turns into a massive bureaucracy that helps no one.”
Instead, she said, politicians should focus on getting money directly to South Carolina citizens.
Patient advocates and many lawmakers, including some Republicans, say they remain concerned that the bill would make coverage unaffordable for people with pre-existing conditions, which include mental health disorders.
Sue Berkowitz, director of SC Appleseed Legal Justice Center, which advocates for low-income South Carolinians, said the bill that had passed the House was not an improvement over the original proposal, despite the addition of provisions meant to quiet concerns about coverage for people with pre-existing conditions.
“We’re still gonna see lots of people lose benefits, especially through Medicaid,” Berkowitz said. “And I think ultimately we’ll see different eligibility groups competing for who gets what services. I don’t see anything beneficial coming from the proposed amendments.”
The GOP legislation provides an alternative for people whose medical histories might make individual coverage unaffordable: high-risk pools for the medically uninsurable.
The bill provides $15 billion over nine years and another $8 billion over five years to help cover people with pre-existing, chronic conditions through the high-risk pools. But that would cover only about 110,000 of the estimated 2.2 million people with individual coverage who have pre-existing conditions, according to Avalere Health, a D.C. consulting firm.
The GOP measure provides another $100 billion pot of money to help states, sick plan members and insurers pay medical costs. If all that money – and the other $23 billion – went solely for people with pre-existing conditions, it would cover just 600,000 people, Avalere found.
At least 20 percent of Americans 65 or older could be diagnosed with some sort of mental health disorder, according to the American Psychological Association.
“It’s sort of a cascading problem” for seniors, said Teresa Arnold, the state director of the AARP’s South Carolina chapter. “If we don’t take care of them during this period of time with their health care coverage and help them be able to take care of their health care, and then they use up all their money, they end up costing the state a lot more down the road because they will depend on state resources.”
Tony Pugh contributed to this article.